Apparatus for enabling blind endotracheal tube or guide wire insertion into the trachea

ABSTRACT

An intubation assistance device facilitates insertion of an endotracheal tube or a guide wire into a patient&#39;s trachea without requiring a laryngoscope. The device includes a curved flexible tubular member that has a proximal portion having a proximal end, a distal portion having a distal end, and a curved portion between the proximal portion and the distal portion. A lumen extends from the proximal end of the tubular member and terminates in the curved portion of the tubular member. The lumen is sized and shaped so that an endotracheal tube and/or a guide wire is axially moveable through the lumen. A ramp is disposed at a distal end of the lumen, and is angled to facilitate insertion of the endotracheal tube and/or guide wire into the patient&#39;s trachea. The distal portion of the tubular member includes an esophageal protrusion that is configured to be inserted in the patient&#39;s esophagus.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to claims benefit of U.S. ProvisionalApplication No. 62/822,041, filed on Mar. 21, 2019, entitled “APPARATUSFOR ENABLING BLIND BOUGIE INSERTION INTO THE TRACHEA.” That applicationis hereby incorporated by reference herein in its entirety.

BACKGROUND Field of the Art

This disclosure relates to medical devices. More specifically, thepresent disclosure relates to human airway management systems.

Discussion of the State of the Art

Endotracheal tubes are commonly used for managing and ventilating theairways of patients who have stopped breathing. In order to establish adefinitive airway, the endotracheal tube is placed in the trachea with acuff inflated below the vocal cords. However, placing endotracheal tubesinto the patient's trachea is no easy task. It involves passing anendotracheal tube into the trachea under direct laryngoscopy, aprocedure that requires significant skill and experience to practiceconsistently and reliably. Even for skilled practitioners, success ratesare low for proper intubation in a first attempt. In many hospital andlab settings, it is not feasible to provide and maintain the educationand skill set needed for practitioners to be proficient at intubations.Additionally, at nighttime or in rural locations, advance airwayproviders, who are skilled and experienced in proper intubationtechniques, may not be readily available.

Moreover, according to traditional endotracheal tube placementprocedures, once an endotracheal tube (hereinafter also referred to as“ET tube”) is placed into a patient, tube placement must be verified.This multi-step verification process often creates delays in applyingchest compressions and radiographic imaging, which may be necessary orcritical in saving a patient's life.

Sometimes, as a result of unavailability of skilled practitioners or thedelay caused by traditional ET tube placement methodologies, somepatients do not receive proper intubations. Instead, medicalprofessionals often begin ventilating patients with a bag valve mask(BVM) until a more experienced provider arrives to secure a moredefinitive airway. BVM, however, sometimes does more harm than good. Theproblem with BVMs is that in providing positive pressure, BVMventilations ventilate not only the lungs, but also force air into thestomach, often leading to gastric inflation and subsequent emesis. Thisgreatly increases the change of aspiration of stomach contents into thelungs, which can significantly compromise the patient's prognosis.

As an alternative to establishing a definitive airway, supraglotticairway devices are used for advanced airway management. Supraglotticairway devices isolate and ventilate above the glottic opening. As such,supraglottic airway devices keep the upper airway open and usepositive-pressure ventilation, but do not establish a definitive airway.Although supraglottic airway devices may be easier to use and requireless training than placing an ET tube under direct laryngoscopy, theyare not without complications. For example, in some cases, supraglotticairway devices have been shown to provide inadequate ventilation and areineffective for patients with upper airway edema.

What is needed is a reliable, easy to use apparatus for establishing adefinitive airway.

SUMMARY

The present invention overcomes the challenges described above with adevice that can be used to place a bougie (or a guide wire) or ET tubeinto a patient's trachea. The device does not require the aid oflaryngoscope, and can be used by professionals who are not specificallytrained in ET tube placement methodologies.

The present invention accomplishes these objective by using a lumenthat, when inserted into a patient's mouth without the aid of alaryngoscope, travels past the oropharynx and seats itself within thehypopharynx. The device is further comprised of a ramp that extendsbeyond the lumen at an angle greater than 90 degrees. When a guide wireor ET tube is placed within the lumen, it travels to the ramp andbecomes placed in the trachea. As such, the present invention enablesusers to place a guide wire or ET tube into the trachea without the aidof an imaging device and enables users who are not specifically trainedin ET tube placement to perform intubation.

As such, the present invention significantly reduces the complexity andcosts associated with training and staffing airway specialists.Moreover, the present invention enables users to provide a reliableairway to patients who are in urgent or critical need.

BRIEF DESCRIPTION OF THE DRAWING FIGURES

The accompanying drawings illustrate several embodiments and, togetherwith the description, serve to explain the principles of the inventionaccording to the embodiments. It will be appreciated by one skilled inthe art that the particular arrangements illustrated in the drawings aremerely exemplary and are not to be considered as limiting of the scopeof the invention or the claims herein in any way.

FIG. 1 illustrates an apparatus of the present invention in accordancewith an embodiment of the invention.

FIG. 2 also illustrates an apparatus of the present invention inaccordance with an embodiment of the invention.

FIGS. 3A-3E are perspective, side, front, top, and close-up views,respectively, of an apparatus of the present invention in accordancewith another embodiment of the invention.

FIGS. 4A and 4B are cross-sectional views of a patient that illustratethe placement of the apparatus in FIGS. 3A-3E in the patient's airwayand the placement of an ET tube in the apparatus.

DETAILED DESCRIPTION

The apparatus of the present invention is for enabling blind insertionof an endotracheal tube (ET tube) or a guide wire into a patient'strachea. In one embodiment, the apparatus comprises a lumen comprising adistal and a proximal end, the lumen for insertion into a patient'smouth, wherein the distal end of the lumen is seated within thepatient's hypopharynx when the lumen is placed into the patient, a rampdisposed near the distal end of the lumen, the ramp enabling a guidewire to be placed directly into the patient's trachea, the ramp havingan opening that forms an approximately 100 degree angle with the lumen,a curved portion disposed within the lumen for guiding the distal end ofthe lumen into the patient's hypopharynx when the lumen is inserted intothe patient's mouth, and a guide member disposed near the proximal endof the lumen, the guide member notifying a user that the distal end ofthe lumen is seated within the patient's hypopharynx.

In another embodiment, the apparatus includes a lumen having a distalend and a proximal end. The lumen is sized and shaped to accommodate anET tube. The distal end of the lumen is coextensive with a wedge-shapedprotrusion that is configured to pass through the vocal cords when theapparatus is completely inserted. Below the wedge-shaped protrusion isan esophageal protrusion that is configured to be seated within thepatient's esophagus when the device is fully inserted. Between thewedge-shaped protrusion and the esophageal protrusion is a gap that isconfigured to accommodate the junction between the esophagus and thevocal cords. For example, the gap has a V-shaped surface that may be incontact with the arytenoid, such as the arytenoid cartilage, arytenoidmuscles, and/or the interarytenoid notch. The apparatus further includesa foot or spacer that pushes against the patient's hypopharynx to ensurethat the protrusions are correctly positioned in the vocal cords and theesophagus.

Various embodiments of the inventive apparatus, system, and method aredisclosed herein, including numerous alternative arrangements. However,it should be appreciated that these are presented for illustrativepurposes only and are not limiting of the embodiments contained hereinor the claims presented herein in any way. One or more of thearrangements may be widely applicable to numerous embodiments, as may bereadily apparent from the disclosure. In general, arrangements aredescribed in sufficient detail to enable those skilled in the art topractice one or more of the embodiments, and it should be appreciatedthat other arrangements may be utilized and that structural, logical,software, electrical and other changes may be made without departingfrom the scope of the embodiments. Particular features of one or more ofthe embodiments described herein may be described with reference to oneor more particular embodiments or figures that form a part of thepresent disclosure, and in which are shown, by way of illustration,specific arrangements of one or more of the aspects. It should beappreciated, however, that such features are not limited to usage in theone or more particular embodiments or figures with reference to whichthey are described. The present disclosure is neither a literaldescription of all arrangements of one or more of the embodiments nor alisting of features of one or more of the embodiments that must bepresent in all arrangements.

Headings of sections provided in this patent application and the titleof this patent application are for convenience only and are not to betaken as limiting the disclosure in any way.

Devices that are in communication with each other need not be incontinuous communication with each other, unless expressly specifiedotherwise. In addition, devices that are in communication with eachother may communicate directly or indirectly through one or morecommunication means or intermediaries, logical or physical.

A description of an aspect with several components in communication witheach other does not imply that all such components are required. To thecontrary, a variety of optional components may be described toillustrate a wide variety of possible embodiments and in order to morefully illustrate one or more embodiments. Similarly, although processsteps, method steps, algorithms or the like may be described in asequential order, such processes, methods and algorithms may generallybe configured to work in alternate orders, unless specifically stated tothe contrary. In other words, any sequence or order of steps that may bedescribed in this patent application does not, in and of itself,indicate a requirement that the steps be performed in that order. Thesteps of described processes may be performed in any order practical.Further, some steps may be performed simultaneously despite beingdescribed or implied as occurring non-simultaneously (e.g., because onestep is described after the other step). Moreover, the illustration of aprocess by its depiction in a drawing does not imply that theillustrated process is exclusive of other variations and modificationsthereto, does not imply that the illustrated process or any of its stepsare necessary to one or more of the embodiments, and does not imply thatthe illustrated process is preferred. Also, steps are generallydescribed once per aspect, but this does not mean they must occur once,or that they may only occur once each time a process, method, oralgorithm is carried out or executed. Some steps may be omitted in someembodiments or some occurrences, or some steps may be executed more thanonce in a given aspect or occurrence.

When a single device or article is described herein, it will be readilyapparent that more than one device or article may be used in place of asingle device or article. Similarly, where more than one device orarticle is described herein, it will be readily apparent that a singledevice or article may be used in place of the more than one device orarticle.

The functionality or the features of a device may be alternativelyembodied by one or more other devices that are not explicitly describedas having such functionality or features. Thus, other embodiments neednot include the device itself.

Techniques and mechanisms described or referenced herein will sometimesbe described in singular form for clarity. However, it should beappreciated that particular embodiments may include multiple iterationsof a technique or multiple instantiations of a mechanism unless notedotherwise. Process descriptions or blocks in figures should beunderstood as representing modules, segments, or portions of code whichinclude one or more executable instructions for implementing specificlogical functions or steps in the process. Alternate implementations areincluded within the scope of various embodiments in which, for example,functions may be executed out of order from that shown or discussed,including substantially concurrently or in reverse order, depending onthe functionality involved, as would be understood by those havingordinary skill in the art.

System Overview

FIGS. 1 and 2 illustrate the inventive apparatus in accordance with anembodiment of the invention. It is comprised of a lumen 102, anexpansion member 104, a ramp 106, a flexible curved portion 108, and aguide member 110. The apparatus shown in FIGS. 1 and 2 is an exemplaryembodiment of the invention. However, the present invention is notintended to be limited to this particular embodiment. Alternatives, inaccordance to the description provided herein, including those thatwould be readily apparent to a person or ordinary skill in the art arealso encompassed in the present disclosure.

Lumen

The lumen 102, in accordance with one embodiment of the invention, isfor placing in a patient's mouth. When placed in such a manner, thelumen 102 extends from the patient's mouth, extends past the patient'soropharynx, and seats itself within the patient's hypopharynx. In oneembodiment, the lumen 102 may be comprised of an elongated hollow tubeof medical grade plastic having a flexible or semi-flexible shape.

In one embodiment of the invention, the lumen 102 has an interiordiameter that is at least large enough to accommodate a guide wire suchas a bougie. In one embodiment of the invention, the lumen 102 may becomprised of an interior compartment that subdivides the lumen 102 intotwo lumens. In such an embodiment, at least one interior compartment mayspecifically guide the guide wire to the ramp, as disclosed furtherbelow. In this configuration, the guide wire lumen/compartment may havean interior diameter that is larger than the exterior diameter of theguide wire.

Expansion Member

In one embodiment of the invention, the expansion member 104 is disposedat the distal end of the lumen 102. In one embodiment of the invention,the expansion member 104 seals the esophagus, or at least fits snuglyover a patient's laryngeal inlet when in use. The expansion member 104may have an opening that is co-extensive with the internal portion ofthe lumen 102. The interior diameter of the expansion member 104 and thelumen 102 may be generally constant, but the diameter of the expansionmember 104 is greater than the exterior diameter of the lumen 102.

Ramp

In one embodiment of the invention, a ramp 106 is disposed near thedistal end of the lumen 102 and proximal to the expansion portion 104.The ramp 106, as illustrated in FIGS. 1 and 2, extends beyond the lumen102 at an angle greater than 90 degrees. In one embodiment, the ramp 106extends at an approximately 100 degree angle from the lumen 102. Thespecific angle at which the ramp 106 extends from the lumen 102 mayvary, as would be readily apparent to a person of ordinary sill in theart, without departing from the scope of the invention so long as theramp enables a guide wire or a bougie to enter the trachea, or morespecifically, the rima glottidis, which may be surrounded by vocal foldson either side.

In one embodiment of the invention, the ramp 106 is curved. The specificcurvature of the ramp 106 may vary, as would be readily understood by aperson of ordinary skill in the art, without departing from the scope ofthe invention to the extent that the ramp 106 enables a guide wire or abougie to enter the trachea.

In one embodiment, the interior diameter of the ramp 106 is greater thanthe exterior diameter of a guide wire or a bougie. This feature of thepresent invention permits a guide wire to safely pass through the lumen102, through the ramp 106, and into the trachea. An ET tube may bepassed over the bougie to complete the intubation process.

Flexible Curved Portion

The lumen 102 of the present invention may be comprised of a flexible ora semi-flexible curved portion 108 that enables the lumen 102 toproperly travel past the patient's oropharynx and to the patient'shypopharynx. In one embodiment of the invention, the curved portion 108may enable the lumen 102 to take the same shape as the curve formed bythe interior portions of the patient's nasopharynx, oropharynx, andhypopharynx. Moreover, the curved portion 108 is flexible, which enablesit to take a variety of different shapes to accommodate a variety ofdifferent patients and the dimensions of their interior organs andstructures.

Guide Member

The guide member 110 may be disposed along the proximal end of the lumen102. The guide member 110 may provide an indication to a user that thelumen 102 has reached the patient's trachea. In one embodiment of theinvention, the guide member 110 may be indications or indentationsdisposed along the lumen 102, which may passively notify or alter a userto stop inserting the lumen 102 further into the patient. In oneexample, when an indication or indentation on the guide member 110reaches the patient's teeth, that may represent an indication that theuser should stop inserting the lumen 102 into the patient because thedistal end of the lumen 102 has reached the patient's trachea. Thespecific design and the number of guide members 110 that may be disposedalong the lumen 102 may vary, as would be readily apparent to a personor ordinary skill in the art, without departing from the scope of theinvention to the extent that the guide member 110 passively guides auser as to whether to continue inserting the lumen 102 into a patient orto stop.

An intubation assistance device 300 in accordance with anotherembodiment of the present invention is depicted in FIGS. 3A-3E. Ingeneral, the device 300 is configured to be introduced through the mouthof a patient, and passed through the oropharynx and hypopharynx untilthe distal end of the device 300 is positioned in the esophagus, in thevocal cords, and contacts the arytenoid. As such, the distal end of thedevice 300 is shaped to have a first protrusion that fits in the vocalcords, a second protrusion that fits in the esophagus, and a spacebetween the two protrusions that accommodates the junction between theesophageal opening and the vocal cords. For example, the space betweenthe protrusions has a V-shaped surface that may be in contact with thearytenoid, such as the arytenoid cartilage, arytenoid muscles, and/orthe interarytenoid notch.

The intubation assistance device 300 includes a curved, flexible tubularmember 302 that has a proximal portion 304, a distal portion 306, and acurved portion 308 between the proximal portion 304 and the distalportion 306. The tubular member 302 is made of medical grade plastic,and is flexible or semi-flexible. The curved portion 308 may enable thetubular member 302 to take the same shape as the curve formed by theinterior portions of the patient's nasopharynx, oropharynx, andhypopharynx. Moreover, the tubular member 302 is flexible, which enablesit to take a variety of different shapes to accommodate a variety ofdifferent patients and the dimensions of their interior organs andstructures.

A partially enclosed lumen 310 extends from the proximal end 312 of thetubular member 302 to the curved portion 308 of the tubular member 302.The lumen 310 is sized and shaped to accommodate an ET tube and has alongitudinal opening 314 so that, after the ET tube is positioned in thetrachea of the patient, the intubation assistance device 300 can beremoved while the ET tube remains in place in the trachea. As such, theinner diameter of the lumen 310 is slightly larger than the outerdiameter of an ET tube so that the ET tube can move axially through thelumen 310.

Attached to the proximal end 312 of the tubular member 302 is a syringeholder 332 that also serves as a grip or finger hold during insertionand removal of the device 300. Using the syringe holder 332, the ET tubeand attached syringe can be pre-loaded on the device 300 for fasterintubation, thus securing an airway more quickly. The syringe holder 332can also be used to maintain positive control of the ET tube whileinflating the balloon cuff on the ET tube once the tube is in place.After the cuff is inflated, the device 300 may be removed while the ETtube remains in place.

The angle of the curved portion 308 is optimized so that the proximalend 312 of the tubular member 302 may remain outside of the mouth of thepatient while the distal portion 306 is angled towards the larynx of thepatient. The angle of the curved portion 308 may be different indifferent sized devices. For example, the angle of the curved portion308 in a pediatric device may be different from the angle of the curvedportion 308 in a device intended for use on a large adult. In general,the angle 318 between the proximal portion 304 and the distal portion306 is between 100 and 160 degrees.

The proximal end 312 of the intubation assistance device 300 remainsoutside of the mouth of the patient, while the distal portion 306 of thedevice 300 is positioned generally in the larynx of the patient. Theintubation assistance device 300 further includes a foot or spacer 322that presses against the posterior side of the hypopharynx in order tocorrectly position the distal portion 306 of the device 300 forintubation. The spacer 322 is attached to the distal portion 306 and thecurved portion 308 of the tubular member 302. In this manner, theintubation assistance device 300 facilitates ET tube placement forestablishing a definitive airway. Due to the geometry of the device 300,it is relatively easy to use to establish a direct pathway to thetrachea without the use of a laryngoscope.

A ramp 324 is disposed in the distal portion 306 of the device 300 andis coextensive with the lumen 310. That is, the distal end of the lumen310 is adjacent to the ramp 324. The ramp 324 is a relatively short,wedge-shaped protrusion that is sized and shaped to fit into thepatient's vocal cords. As such, it should be well understood by a personof ordinary skill in the art that the size and shape of the ramp 324depends upon the size of the patient in which the device 300 is used.For example, the ramp 324 in a device 300 to be used on a child will besmaller than the ramp 324 in a device 300 to be used on a large adultpatient.

Below the ramp 324 is an esophageal protrusion 326 that is sized andshaped to fit within the esophagus of the patient during an intubationprocedure. Compared to the ramp 324, the esophageal protrusion 326 islong and extends distally further than the ramp 324. The esophagealprotrusion 326 on the distal portion 306 of the device 300 has acylindrical shape with a tapered or flattened distal end 330. Thetapered or flattened distal end 330 provides an atraumatic tip forfacilitating the insertion of the esophageal protrusion 326 into theesophagus. The esophageal protrusion 326 protrudes a relatively longdistance compared to the length of the ramp 324. The esophagealprotrusion 326 is sized and shaped to fit in the proximal end of thepatient's esophagus and/or the distal portion of the hypopharynx. Assuch, it should be well understood by a person of ordinary skill in theart that the size and shape of the esophageal protrusion 326 dependsupon the size of the patient in which the device 300 is used. Forexample, the esophageal protrusion 326 in a device 300 to be used on achild will be smaller than the esophageal protrusion 326 in a device 300to be used on a large adult patient.

A gap 328 between the ramp 324 and the esophageal protrusion 326 issized and shaped to accommodate the tissue that lies between theesophagus and the vocal cords. For example, the gap 328 has a V-shapedsurface that contacts the arytenoid area, such as the arytenoidcartilage, arytenoid muscles, and/or the interarytenoid notch that isdisposed between the vocal cords and the esophagus. The gap 328 has aV-shape or a wedge shape.

The foot or spacer 322 is configured to rest against the posteriorsurface of the hypopharynx in order to urge the ramp 324 and theesophageal protrusion 326 into the correct location. The spacer 322 istriangular and is attached to the distal portion 306 and the curvedportion 308 of the tubular member 302. As shown in the top-down view inFIG. 3D, the spacer 322 is wider than the distal portion 306 of thetubular member 302. The spacer 322 ensures a snug fit of the device 300within the hypopharynx so that the ramp 324 and the esophagealprotrusion 326 remain in place during the intubation procedure. Thespacer 322 and the ramp 324 are disposed on opposite sides of thetubular member 302, with the ramp 324 disposed on top of the tubularmember 302 and the spacer 322 disposed below the tubular member 302.

FIGS. 4A and 4B depict the intubation assistance device 300 in positionin a patient 400 with the ET tube 420 inserted therethrough. The device300 is introduced through the mouth 402 of the patient 400 and movesdistally down the throat 404 until the distal portion 306 of the device300 is properly lodged in the esophagus 406 and vocal cords 408. Asshown more clearly in FIG. 4B, when the device 300 is properlypositioned, the ramp 324 is disposed in the vocal cords 408 and theesophageal protrusion 326 is disposed in the esophagus 306. Thewedge-shaped gap 328 between the ramp 324 and the esophageal protrusion326 is sized and shaped to accommodate the tissue 410 that lies betweenthe vocal cords and the esophagus. The tissue 410 includes the arytenoidarea. The wedge-shaped gap 328 has a V-shaped surface that may be incontact with the arytenoid cartilage, the arytenoid muscles, and/or theinterarytenoid notch. The spacer 322 of the device 300 ensures properplacement of the device 300. That is, the spacer 322 guides the device300 into the proper position during insertion and creates a snug fitbetween the device 300 and the hypopharynx 412 of the patient 400. Inthis manner, the spacer 322 stabilizes the device 300 so that the ramp324 and esophageal protrusion 326 remain in their correct positionsduring intubation.

The skilled person will be aware of a range of possible modifications ofthe various embodiments described above. Accordingly, the presentinvention is defined by the claims and their equivalents.

Additional Considerations

As used herein any reference to “one embodiment” or “an embodiment”means that a particular element, feature, structure, or characteristicdescribed in connection with the embodiment is included in at least oneembodiment. The appearances of the phrase “in one embodiment” in variousplaces in the specification are not necessarily all referring to thesame embodiment.

Some embodiments may be described using the expression “coupled” and“connected” along with their derivatives. For example, some embodimentsmay be described using the term “coupled” to indicate that two or moreelements are in direct physical or electrical contact. The term“coupled,” however, may also mean that two or more elements are not indirect contact with each other, but yet still co-operate or interactwith each other. The embodiments are not limited in this context.

As used herein, the terms “comprises,” “comprising,” “includes,”“including,” “has,” “having” or any other variation thereof, areintended to cover a non-exclusive inclusion. For example, a process,method, article, or apparatus that comprises a list of elements is notnecessarily limited to only those elements but may include otherelements not expressly listed or inherent to such process, method,article, or apparatus. Further, unless expressly stated to the contrary,“or” refers to an inclusive or and not to an exclusive or. For example,a condition A or B is satisfied by any one of the following: A is true(or present) and B is false (or not present), A is false (or notpresent) and B is true (or present), and both A and B are true (orpresent).

In addition, use of the “a” or “an” are employed to describe elementsand components of the embodiments herein. This is done merely forconvenience and to give a general sense of the invention. Thisdescription should be read to include one or at least one and thesingular also includes the plural unless it is obvious that it is meantotherwise.

Upon reading this disclosure, those of skill in the art will appreciatestill additional alternative structural and functional designs for asystem and a process for creating an interactive message through thedisclosed principles herein. Thus, while particular embodiments andapplications have been illustrated and described, it is to be understoodthat the disclosed embodiments are not limited to the preciseconstruction and components disclosed herein. Various apparentmodifications, changes and variations may be made in the arrangement,operation and details of the method and apparatus disclosed hereinwithout departing from the spirit and scope defined in the appendedclaims.

What is claimed is:
 1. An intubation assistance device for facilitatinginsertion of an endotracheal tube into a patient's trachea, the devicecomprising: a curved flexible tubular member comprising a proximalportion having a proximal end, a distal portion having a distal end, anda curved portion between the proximal portion and the distal portion; alumen that extends from the proximal end of the tubular member andterminates in the curved portion of the tubular member, wherein thelumen is sized and shaped so that the endotracheal tube is axiallymoveable through the lumen; a ramp that is coextensive with the distalend of the lumen, wherein the ramp is configured to be inserted in thepatient's vocal cords; and an esophageal protrusion in the distalportion of the tubular member, wherein the esophageal protrusion isconfigured to be inserted in the patient's esophagus.
 2. The device ofclaim 1, further comprising a gap between the ramp and the esophagealprotrusion, wherein the gap is configured to accommodate tissue disposedbetween the vocal cords and the esophagus when the ramp is positioned inthe vocal cords and the esophageal protrusion is positioned in theesophagus.
 3. The device of claim 2, wherein the gap comprises aV-shaped surface configured to be in contact with at least one of: thearytenoid cartilage, arytenoid muscles, and the interarytenoid notch. 4.The device of claim 1, wherein the lumen comprises a longitudinalopening along the length of the lumen, wherein the longitudinal openingis sized to allow an endotracheal tube disposed within the lumen to beremoved through the longitudinal opening in the lumen.
 5. The device ofclaim 1, further comprising a spacer attached to the distal portion andthe curved portion of the tubular member, wherein the spacer and theramp are disposed on opposite sides of the tubular member.
 6. The deviceof claim 5, wherein the spacer is configured to fit within thehypopharynx of the patient.
 7. The device of claim 6, wherein the spaceris configured to contact a posterior surface of the hypopharynx.
 8. Thedevice of claim 1, wherein an angle between the proximal portion and thedistal portion of the tubular member is between 100 and 160 degrees. 9.The device of claim 1, wherein the esophageal protrusion extendsdistally further than the ramp.
 10. An intubation assistance device forfacilitating insertion of an endotracheal tube or a guide wire into apatient's trachea, the device comprising: a curved flexible tubularmember comprising a proximal portion having a proximal end, a distalportion having a distal end, and a curved portion between the proximalportion and the distal portion; a lumen that extends from the proximalend of the tubular member and terminates in the curved portion of thetubular member, wherein the lumen is sized and shaped so that at leastone of an endotracheal tube and a guide wire is axially moveable throughthe lumen; a ramp disposed at a distal end of the lumen, wherein theramp is angled to facilitate insertion of the at least one of theendotracheal tube and the guide wire into the patient's trachea; and anesophageal protrusion in the distal portion of the tubular member,wherein the esophageal protrusion is configured to be inserted in thepatient's esophagus.
 11. The device of claim 10, where in an anglebetween the proximal portion and the distal portion of the tubularmember is between 100 and 160 degrees.
 12. The device of claim 10,wherein the ramp is a wedge-shaped protrusion that is configured to beinserted into the patient's vocal cords.
 13. The device of claim 12,further comprising a gap between the wedge-shaped protrusion and theesophageal protrusion, wherein the gap is configured to accommodatetissue disposed between the vocal cords and the esophagus when thewedge-shaped protrusion is positioned in the vocal cords and theesophageal protrusion is positioned in the esophagus.
 14. The device ofclaim 13, wherein the gap comprises a V-shaped surface that is sized andshaped to be in contact with at least one of: the arytenoid cartilage,the arytenoid muscles, and the interarytenoid notch.
 15. The device ofclaim 10, wherein the lumen comprises a longitudinal opening along thelength of the lumen, wherein the longitudinal opening is sized to allowan endotracheal tube disposed within the lumen to be removed through thelongitudinal opening in the lumen.
 16. The device of claim 10, whereinthe ramp and the lumen are arranged so that, during an intubationprocedure, the at least one of the endotracheal tube and the guide wireexits the distal end of the lumen, contacts the ramp, and passes throughthe vocal cords.
 17. The device of claim 10, wherein the esophagealprotrusion extends distally further than the ramp.
 18. The device ofclaim 10, wherein the ramp is coextensive with the esophagealprotrusion.